Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map


Self-Assessment Questions

Critical Care Medicine

Pulmonary Disease in the Intensive Care Unit: Review Questions

Joseph Varon, MD, FACP, FCCP, FCCM, Paul E. Marik, MD, FCCP, FCCM, and Robert E. Fromm, Jr, MD, MPH, FACP, FCCP, FCCM

Dr. Varon is an Associate Professor of Medicine, Baylor College of Medicine, Houston, TX; and a member of the Hospital Physician Editorial Board. Dr. Marik is a Professor of Medicine, Anesthesiology, and Critical Care, University of Pittsburgh, Pittsburgh, PA. Dr. Fromm is an Associate Professor of Medicine, Baylor College of Medicine, Houston, TX.


Choose the single best answer for each question.

1. A patient is receiving supportive therapy in the intensive care unit for acute respiratory distress syndrome (ARDS). On the eighth day of treatment, a bronchoscopic directed protected specimen brushing is performed to evaluate a new infiltrate. Which of the following microorganisms is NOT likely to be isolated?
  1. Haemophilus influenzae
  2. Klebsiella pneumoniae
  3. Prevotella melaninogenica
  4. Pseudomonas aeruginosa
  5. Staphylococcus aureus
Click here to compare your answer.


2. A 24-year-old man with asthma is intubated for respiratory failure. The patient is sedated with lorazepam and paralyzed with doxacurium. The initial ventilator settings are as follows: assist/control mode rate, 12 breaths/min; tidal volume, 700 mL; inspiratory flow rate, 90 L/min; positive end-expiratory pressure (PEEP), 0 cm H2O. As the peak airway pressure reaches 53 cm H2O, the flow rate is reduced to 60 L/min with a decrease in the peak airway pressure to 42 cm H2O. Thirty minutes later, the patients blood pressure has decreased from 140/75 to 70/45 mm Hg. Auscultation reveals diminished breath sounds bilaterally with both inspiratory and expiratory rhonchi. Which of the following is the most appropriate next step?

  1. Administer a 500-mL bolus of lactated Ringer’s solution intravenously
  2. Further decrease the inspiratory flow rate
  3. Increase the PEEP to 10 cm H2O
  4. Insert bilateral chest tubes
  5. Reduce the respiratory rate
Click here to compare your answer.


3. Which of the following best describes the appearance of a pneumothorax on a radiograph taken with the patient in the supine position?
  1. Apical capping
  2. Apical hyperlucency
  3. Deep sulcus sign
  4. Increased radiolucency of the lung fields
  5. Multiple vertical lucency sign
Click here to compare your answer.


4. A patient with ARDS develops refractory hypoxemia despite attempts at various modes of mechanical ventilation. The patient is finally turned and ventilated in the prone position. The PaO2 increases significantly with a fall in the pulmonary admixture ratio. Which of the following best explains the improvement in oxygenation?

  1. Change in regional diaphragmatic movement
  2. Increased functional residual capacity
  3. Increased mobilization of secretions
  4. Increased perfusion to the nondependent ventral lung regions
  5. Increased ventilation to the nondependent ventral lung regions
Click here to compare your answer.
 

Self-Assessment Questions Main Page Top

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj